Discusses infection caused by overgrowth of Candida albicans, a type of yeast that normally lives in the vagina. Covers symptoms like itching or soreness in vagina or burning when you urinate or have sex. Looks at treatment with medicines like Monistat.

Vaginal Yeast Infections

Topic Overview

What is a vaginal yeast infection?

Yeast is a
fungus that normally lives in the vagina in small numbers. A vaginal yeast
infection means that too many yeast cells are growing in the
vagina. These infections are very common. Although
they can bother you a lot, they are not usually serious. And treatment is
simple.

What causes a vaginal yeast infection?

Most yeast
infections are caused by a type of yeast called Candida albicans.

A healthy
vagina has many bacteria and a small number of yeast
cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms—like the yeast—under control.

When something happens to change the balance of these organisms,
yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes
this imbalance. The high estrogen levels caused by pregnancy or
hormone therapy can also cause it. So can
certain health problems, like
diabetes or
HIV infection.

What are the symptoms?

A yeast infection causes
itching or soreness in the vagina and sometimes causes pain or burning when you
urinate or have sex. Some women also have a thick, clumpy, white discharge that
has no odor and looks a little like cottage cheese.

These symptoms
are more likely to occur during the week before your menstrual period.

How is a vaginal yeast infection diagnosed?

It's
easy to guess wrong about a vaginal infection. See your doctor if you aren't
sure what you have or if this is the first time you have had these symptoms.
Also see your doctor if you are pregnant. Your doctor may want to do a vaginal
exam.

How is it treated?

If you have had a yeast
infection before and can recognize the symptoms, and you aren't pregnant, you
can treat yourself at home with medicines you can buy without a prescription.
You can use an antifungal cream, or a suppository that you put into your
vagina, or antifungal tablets that you swallow.

If your symptoms
are mild, you may want to wait to see if they clear up on their own.

Yeast infections are common during pregnancy. If you are pregnant, don't
use medicine for a yeast infection without talking to your doctor first.

If you use a cream or suppository to treat the infection, don't depend on
a condom or diaphragm for birth control. The oil in some medicines weakens
latex, the material often used to make these devices.

Many women
have infections that come back. If you have more than four yeast infections in
a year, see your doctor. He or she may do some tests to see if your yeast
infections are being caused by another health problem, such as diabetes.

Most yeast infections involve Candida albicans (C. albicans), a yeast that can be
treated effectively with standard yeast infection medicine.
Recurrent vaginal yeast infections tend to involve
non–C. albicans types of yeast, which are more resistant
to the standard treatments for C. albicans yeast
infections.

Symptoms

The symptoms of
vaginal yeast infection include:

Vaginal itching that is often severe.

Vaginal discharge that is usually white, thick, clumpy, and
odorless.

Red, irritated skin around the opening to the vagina
(labia).

Pain while urinating when urine touches irritated
skin.

Pain in the vagina during sexual intercourse.

Symptoms of a vaginal yeast infection are more likely to
occur during the week before a menstrual period.

There are
other conditions with similar symptoms, such as
bacterial vaginosis or a
sexually transmitted infection (STI). Itching and redness of
the
vulva can also be caused by a reaction to vaginal
products such as soap, bath oils, spermicidal jelly, or douches. If you are
unfamiliar with your symptoms, see your doctor for an accurate
diagnosis.

What Happens

Vaginal yeast infections often clear up on their own without treatment, usually when
menstruation begins. Menstrual blood raises the
vaginal
pH, causing the number of yeast cells to decrease
because they can't grow in the pH present during menstruation.

There are significant differences between occasional, easily treatable
yeast infections and
recurrent infections that seriously affect a woman's
life. Recurring vaginal yeast infections can be difficult to prevent or cure.
Women who have recurring yeast infections should be evaluated for other causes
(such as
diabetes,
hormone therapy, or treatment-resistant strains of
yeast) so that the cause can be treated or reversed.

What Increases Your Risk

Your risk of getting a
vaginal yeast infection can be increased by a number
of medical and lifestyle factors.

Some of the common things that put you at risk
for vaginal yeast infection include:

Use of
antibiotics. These medicines upset the normal balance
between yeast and bacteria in the vagina. Antibiotics can kill too much "good"
bacteria and result in too much yeast growing in the vagina, sometimes causing
symptoms of a yeast infection.

Problems with your immune system that affect the
normal balance of yeast and bacteria in the body. Having a condition such as
poorly controlled
diabetes or
HIV (human immunodeficiency virus) can lead to too
much yeast growing in the vagina. Taking
corticosteroid medicines sometimes also weakens the
immune system and increases the risk for yeast infections. Pregnant women are
also at higher risk for getting yeast infections because of shifting
hormones that can weaken the immune system.

Wearing tight-fitting,
nonabsorbent pants or undergarments that hold in warmth and
moisture.

Using feminine hygiene sprays, talcs, or perfumes in the
vaginal area.

Douching.

Vaginal yeast infections are not sexually
transmitted. After having unprotected
sex with a partner who has a yeast infection, you may have more than the normal
amount of yeast in your vagina. But if after having sex you develop a yeast
infection that causes symptoms, it is most likely because other things are
also involved.

When To Call a Doctor

Use the following guidelines for
seeking medical care when you have vaginal symptoms.

Have an unusual vaginal discharge, and this
is the first time you have had an infection that might be a
vaginal yeast infection.

Have unusual
vaginal itching.

Have pain during sex or
urination.

Have any other symptoms that may point to a vaginal
infection.

Continue to have symptoms despite home treatment with a
nonprescription medicine.

Have symptoms return within 2 months, and
you have not been taking
antibiotics.

Watchful waiting

If you are sure your symptoms are caused by a
vaginal yeast infection, waiting several days to see if the symptoms clear up
on their own is not harmful, especially if you expect your menstrual period
within that time. Sometimes a menstrual period will relieve the symptoms of a
mild yeast infection. If your symptoms continue, you can use nonprescription
medicine. If symptoms continue after treatment, see your doctor.

Who to see

Health professionals who can diagnose and treat a vaginal
yeast infection include:

Exams and Tests

Your doctor may be able to diagnose
your vaginal symptoms based on your medical history and a
vaginal exam.

If your vaginal
symptoms are not typical of a
vaginal yeast infection, your doctor can look for
signs of yeast or other organisms using a
wet mount test of vaginal discharge.

You
may have other tests if you have vaginal yeast infections that are severe or
that keep coming back (recur), such as:

A vaginal
culture. This test can confirm that you have a yeast
infection. A sample of vaginal discharge can be taken during a wet mount test.
If more than the normal amount of yeast grows in the sample over a short period
of time (a few days), then your symptoms are likely caused by a yeast
infection.

A blood test to find out if you may have
diabetes or another health problem that makes you more
likely to get yeast infections.

Although a yeast infection can be detected during a routine
Pap test, this type of test is not typically done to
diagnose vaginal infections.

Treatment Overview

You have a number of treatment
options for a
vaginal yeast infection, including nonprescription
vaginal medicine, prescription oral or vaginal medicine, or nonprescription
vaginal boric acid capsules.

Only use nonprescription vaginal
yeast infection treatment without a doctor's diagnosis and advice if
you:

Are not pregnant.

Are sure your
symptoms are caused by a vaginal yeast infection. If you have never been diagnosed with a vaginal
yeast infection, see your doctor.

The risk of self-treatment is that your symptoms may be
caused by another vaginal infection, such as a sexually transmitted infection (STI),
that requires different treatment. If you may have been exposed to an STI, it
is best to discuss your symptoms with your doctor before using a
nonprescription medicine. Your doctor may recommend testing for STI if you
have risk factors for these infections.

Yeast infection during pregnancy

Vaginal yeast
infections are common during
pregnancy, likely caused by elevated
estrogen levels. If you are pregnant, don't assume you
have a yeast infection until it is diagnosed, and don't use nonprescription
medicines without discussing your symptoms with your doctor.

Vaginal medicine is often used to treat a vaginal yeast
infection during pregnancy.

Recurrent yeast infection

For a vaginal yeast
infection that recurs within 2 months of treatment, or four times in 1 year
(recurrent vaginal yeast infection), see your doctor.
Further testing or a different treatment may be needed. If you have been using
a nonprescription medicine for your vaginal symptoms, be sure to tell your
doctor. This information could affect what treatment is recommended.

Recurrent vaginal yeast infection can be treated with
prescription oral medicine,
nonprescription vaginal medicine, or
vaginal boric acid capsules, followed by
less frequent medicine over 6 months to 1 year to
prevent reinfection.1

A vaginal yeast
infection is not a sexually transmitted infection (STI). After having unprotected
sex with a partner who has a yeast infection, you may have more than the normal
amount of yeast in your vagina. But if after having sex you develop a yeast
infection that causes symptoms, it is most likely because other factors are
also involved.

What to think about

It is important to complete the
entire recommended treatment to cure a yeast infection.

Vaginal infections caused by types of yeast other than
Candida albicans may be more difficult to cure with
standard antifungal medicine. For treatment-resistant infections, a
culture of vaginal discharge is done to identify the
type of yeast causing the infection.

Prevention

The following actions can help prevent a
vaginal yeast infection.

Eat a
balanced diet rich in fruits, vegetables, whole
grains, and nonfat dairy products. Some women think that eating foods with
lactobacillus organisms, such as yogurt or acidophilus milk, will help prevent
yeast infections. So far there is no evidence for this connection. But eating
foods that contain lactobacillus can be part of a healthy diet.

Control
diabetes. Good control of blood sugar levels decreases
the risk of yeast infections anywhere on your body.

Avoid
unnecessary use of antibiotics. Antibiotics can change the normal balance of
vaginal organisms, allowing excess growth of yeast.

If you practice good genital hygiene, you can also help prevent infection.

After using the toilet, wipe from front to back to avoid spreading yeast or bacteria from your anus to the vagina or urinary tract.

Wear underwear that helps keep your genital area dry and doesn't hold in warmth and moisture. One good choice is cotton underwear.

Avoid tight-fitting clothing, such as panty hose, and tight-fitting jeans. These may increase body heat and moisture in your genital area.

Change out of a wet swimsuit right away. Wearing a wet swimsuit for many hours may keep your genital area warm and moist.

Change pads or tampons often.

Don't douche or use deodorant tampons or feminine sprays, powders, or perfumes. These items can change the normal balance of organisms in your vagina.

Home Treatment

Do not
self-treat a
vaginal yeast infection if you:

Are pregnant.

Are not sure your
symptoms are caused by a vaginal yeast infection. If you have never been
diagnosed with a vaginal yeast infection, see your doctor before treating it
with a nonprescription antifungal cream. Sometimes women think they have a
vaginal yeast infection when symptoms are caused by
a different condition, such as
bacterial vaginosis or a
sexually transmitted infection (STI).

Have
been exposed to a sexually transmitted infection (STI), which would require a
medical exam.

Using nonprescription medicine

When using a
nonprescription vaginal medicine for a vaginal yeast
infection, follow the directions on the package insert, as well as these
guidelines:

Use pads instead of tampons while you are using nonprescription
vaginal medicines. Tampons can absorb the medicine.

Avoid using soap when cleaning the vaginal area—rinse with water only.

If
sexual intercourse is painful, avoid it. Otherwise, use a water-soluble
lubricating jelly (such as K-Y Jelly) to reduce irritation. The oil in antifungal creams or suppositories can weaken latex. This means condoms and diaphragms may break, and you may not be protected from STI or pregnancy.

If the genital area is swollen or painful, sitting in warm water
(in a bathtub or
sitz bath, not a hot tub) may help. Or instead, you
may try putting a cool, damp cloth on the area. Do not rub to try to relieve
itching.

Report your symptoms to your doctor if:

You are not sure that you have a yeast
infection.

Your self-treatment is not working after one complete
course of therapy.

Things to consider

The risk of self-treatment is that
your symptoms may be caused by a type of vaginal infection other than a yeast
infection, such as bacterial vaginosis or a sexually transmitted infection (STI).
If you have pelvic pain or fever, get an evaluation by a doctor.

If you are pregnant, it is important to be evaluated for vaginal
symptoms. Some vaginal infections, such as bacterial vaginosis,
gonorrhea, or
chlamydia, may increase your risk of complications
during pregnancy.

If you have
risk factors for an STI, discuss your symptoms with your doctor before using
a nonprescription medicine. Risk factors for an STI include having sex without a condom or having more than one sex partner.

Talk to your doctor before you try
unproven home treatment methods, such as applying tea tree oil in the vagina or
taking garlic supplements. These treatments have not been well studied. They
may even cause other problems, such as allergic reactions, in some
women.2 Douching is not recommended, because it can
make some infections worse.

Medications

Antifungal medicines are the standard
treatment for a
vaginal yeast infection. You can insert a cream or
suppository antifungal cream into your vagina or take a pill by mouth. Vaginal boric acid capsules are sometimes used.

Antifungal medicines that you take as a pill by mouth affect the entire body
(so it can also treat any yeast infection elsewhere in the body). Vaginal
medicine only affects the area in which it is applied.

What to think about

Antifungal creams and
suppositories that you put into your vagina have fewer
side effects than antifungal pills you take by mouth. This is because vaginal
medicine isn't absorbed into your body and only affects the genital area.
Antifungal pills that are taken by mouth affect your entire body. Side effects
from these pills are rare with one treatment dose. Side effects can include nausea,
headaches, and belly pain. But taking a pill is convenient and is not
messy. Medicine put into the vagina can be uncomfortable. And it may seem like
more of a hassle than taking a pill.

The oil in antifungal creams or suppositories can weaken latex. This means condoms and diaphragms may break, and you may not be protected from STI or pregnancy.

If you are taking the anticoagulant medicine warfarin and you use a
nonprescription
vaginal yeast-fighting medicine, you may have
increased bruising and abnormal bleeding. Talk with your doctor before using an
antifungal medicine along with warfarin.

You are more likely to
use a treatment correctly and complete the treatment if you get to choose the
type you prefer. Talk with your doctor about the advantages and disadvantages
of vaginal and oral medicines, including:

How a medicine can be administered. Most of
the vaginal treatments are available as creams, vaginal tablets, or
suppositories.

Whether oral or vaginal medicine is recommended.
You may prefer to take pills rather than use medicine that is inserted into the
vagina. Or the type of yeast infection you have may respond better to one
method than to the other.

Whether you should avoid sexual intercourse
if you are using vaginal medicine. Some doctors advise that women avoid sex
during treatment.

Whether treatment should be continued during
your menstrual period. Tampons can absorb medicine, so use pads if you are
being treated with vaginal medicines during your period.

Check with your doctor or pharmacist to
see whether you can get a generic form of a prescription medicine. Many generic
medicines are now available to treat vaginal yeast infections. They are often
less expensive than brand-name medicines.

Other Treatment

Some experts may recommend
vaginal boric acid capsules as a treatment option for
vaginal yeast infection, particularly infections that
can't be cured by prescription or nonprescription antifungal yeast infection
medicines.1 Boric acid is a
white, crystalline chemical substance that has antifungal and antiviral
properties. It is used in various pharmaceutical products and is also available
without a prescription.

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